Inzidenz und Spektrum maligner Erkrankungen bei Dialysepatienten in Nordbayern

Hintergrund und Fragestellung: Bei terminaler Niereninsuffizienz ist die Krebsinzidenz gesteigert, wobei bezüglich Häufigkeit und Verteilungsmuster der Tumoren große regionale Unterschiede bestehen. Nachdem in Deutschland dieser Thematik bislang nur wenig Beachtung geschenkt wurde, haben wir eine multizentrische Analyse (8 Dialysezentren) in Nordbayern zum Vorkommen maligner Erkrankungen durchgeführt.

Patienten und Methodik: Von insgesamt 2228 Patienten, die sich wegen terminaler Niereninsuffizienz in den Jahren 1990 - 99 einer Hämodialyse unterzogen hatten, wurden die Datensätze von 1727 Personen ausgewertet. Berücksichtigt wurden ausschließlich Kranke, bei denen ein Malignom im Verlaufe der Dialysetherapie aufgetreten war. Als alters- und geschlechtsentsprechende Vergleichspopulation diente das Krebsregister des Saarlandes, mit dessen Hilfe die erwartete Häufigkeit und Standard-Inzidenz-Ratio (SIR) der verschiedenen Karzinome für die Dialysepatienten berechnet wurden.

Ergebnisse: Insgesamt konnten 125 maligne Erkrankungen dokumentiert werden. Die Krebshäufigkeit war am höchsten im ersten Behandlungsjahr und lag in der Folgezeit deutlich niedriger. Von großer Bedeutung war ferner das Lebensalter der Patienten. So bestanden die höchsten Werte im mittleren Lebensalter (35 - 50 Jahre), während bei älteren Personen deutlich niedrigere Werte bestimmt wurden. Ein erhöhtes Risiko bestand für Malignome der Niere, Harnblase, Prostata, Leber, des Mundraums und Pharynx- und Larynxbereichs sowie des lymphatischen und blutbildenden Systems.

Folgerung: Die hohe Inzidenz von Krebserkrankungen bei terminaler Niereninsuffizienz verdient vermehrte Aufmerksamkeit. Vor allem in der Hochrisikogruppe der jüngeren Dialysepatienten erscheint ein regelmäßiges Screening insbesondere auf Tumoren der Niere und abführenden Harnwege sowie der Leber gerechtfertigt.

Background and objective: In end-stage renal failure the incidence of cancer is increased. With regard to frequency and pattern of distribution of the tumors, there are substantial regional differences. Since this topic has to date received only minimal attention in Germany, we undertook a multi-centric analysis (8 dialysis centres) in North Bavaria in order to address the occurrence of malignant diseases in end-stage renal failure.

Patients and methods: Of a total of 2228 patients, who underwent hemodialysis in the period from 1990 - 99 as a consequence of end-stage renal failure, the medical records of 1727 persons were analysed. Only those patients were considered, whose malignancy was diagnosed in the course of the dialysis. The Saarland cancer register served as a comparative age- and sex-matched population, with which we calculated the expected frequency of the various cancers as well as the standard incidence ratio (SIR) for the dialysis patients.

Results: In total 125 malignant diseases were documented. The cancer incidence was highest in the first year of treatment and was clearly lower in the subsequent periods. Of great importance was the age of the patients. The highest SIR scores were found for patients of middle age (35 - 50 years). An enhanced risk for cancer of the kidney, bladder, prostate, liver, oral cavity and the pharynx and larynx, as well as of the lymphatic and hemopoetic systems was found, while there was no or only a slight increase in the frequency of carcinoma of the mammary gland, stomach, colon-sigma-rectum and bronchial systems.

Conclusion: The high incidence of cancer in end-stage renal failure should be given greater attention. Particularly in the high-risk group of younger dialysis patients, a regular screening - especially for tumors of the kidney, bladder and liver - appears justified.

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